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Emoto T.,Tokushima University | Abeyratne U.R.,Queensland University of Technology | Shono T.,Tokushima University | Nonaka R.,Tokushima University | And 4 more authors.
Proceedings of the 12th IASTED International Conference on Biomedical Engineering, BioMed 2016 | Year: 2016

Snoring is one of the major symptoms of Obstructive sleep apnea syndrome (OSAS) which is associated with serious health consequences. In recent years, speech-like analysis of snores has been performed towards an alterative to polysomnography (PSG) which is considered the gold standard in the diagnosis of OSAS. Human auditory perception has the ability to distinguish between different sounds. In this study, we propose a new method to extract snores from the sound recordings and characterize OSAS using auditory image model, which represents human auditory processing. Our proposed techniques resulted in a sensitivity of 98.4% and specificity of 94.06% for snore and non-snore classification and sensitivity of 85.00±26.87 at a specificity of 95.00±15.81 % for OSAS and non-OSAS classification. These results may indicate the feasibility of developing an OSAS population-screening tool based on automated analysis of non-contact snore.


Kondo E.,Tokushima University | Kondo E.,Kochi National Hospital | Jinnouchi O.,Anan Kyoei Hospital | Ohnishi H.,Anan Kyoei Hospital | And 8 more authors.
Clinical Interventions in Aging | Year: 2014

Patients and methods: The present study included 26 elderly patients with non-obstructive dysphagia. Ointment containing 0.025% capsaicin (0.5 g) was applied to the external auditory canal with a cotton swab under otoscope only once or once a day for 7 days before swallowing of a bolus of colored water (3 mL), which was recorded by transnasal videoendoscopy and evaluated according to the endoscopic swallowing score.Conclusion: These findings suggest that stimulation of the external auditory canal with ointment containing capsaicin improves swallowing function in elderly patients with non-obstructive dysphagia. By the same mechanism used by angiotensin-converting enzyme inhibitors to induce cough reflex, which has been shown to prevent aspiration pneumonia, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in dysphagia patients via Arnold’s ear-cough reflex stimulation.Results: After a single application of 0.025% capsaicin ointment to the right external auditory canal, the endoscopic swallowing score was significantly decreased, and this effect lasted for 60 minutes. After repeated applications of the ointment to each external auditory canal alternatively once a day for 7 days, the endoscopic swallowing score decreased significantly in patients with more severe non-obstructive dysphagia. Of the eight tube-fed patients of this group, three began direct swallowing exercises using jelly, which subsequently restored their oral food intake.Objective: In the present study, an attempt was made to examine the effects of aural stimulation with ointment containing capsaicin on swallowing function in order to develop a novel and safe treatment for non-obstructive dysphagia in elderly patients.Design: A prospective pilot, non-blinded, non-controlled study with case series evaluating a new treatment.Setting: Secondary hospitals. © 2014 Kondo et al.


PubMed | Kagawa University, Anan Kyoei Hospital, Kochi National Hospital, National Institute for Physiological science and Tokushima University
Type: | Journal: Clinical interventions in aging | Year: 2014

In the present study, an attempt was made to examine the effects of aural stimulation with ointment containing capsaicin on swallowing function in order to develop a novel and safe treatment for non-obstructive dysphagia in elderly patients.A prospective pilot, non-blinded, non-controlled study with case series evaluating a new treatment.Secondary hospitals.The present study included 26 elderly patients with non-obstructive dysphagia. Ointment containing 0.025% capsaicin (0.5 g) was applied to the external auditory canal with a cotton swab under otoscope only once or once a day for 7 days before swallowing of a bolus of colored water (3 mL), which was recorded by transnasal videoendoscopy and evaluated according to the endoscopic swallowing score.After a single application of 0.025% capsaicin ointment to the right external auditory canal, the endoscopic swallowing score was significantly decreased, and this effect lasted for 60 minutes. After repeated applications of the ointment to each external auditory canal alternatively once a day for 7 days, the endoscopic swallowing score decreased significantly in patients with more severe non-obstructive dysphagia. Of the eight tube-fed patients of this group, three began direct swallowing exercises using jelly, which subsequently restored their oral food intake.These findings suggest that stimulation of the external auditory canal with ointment containing capsaicin improves swallowing function in elderly patients with non-obstructive dysphagia. By the same mechanism used by angiotensin-converting enzyme inhibitors to induce cough reflex, which has been shown to prevent aspiration pneumonia, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in dysphagia patients via Arnolds ear-cough reflex stimulation.


Kondo E.,Tokushima University | Jinnouchi O.,Anan Kyoei Hospital | Ohnishi H.,Tokushima University | Kawata I.,Anan Kyoei Hospital | Takeda N.,Tokushima University
Journal of Otolaryngology of Japan | Year: 2015

Cough and swallowing reflexes are important airway protective mechanisms against aspiration. Angiotensin converting enzyme ACE inhibitors, one of the side effects of which is cough, have been reported to reduce the incidence of aspiration pneumonia in hypertensive patients with stroke. ACE inhibitors have also been reported to improve the swallowing function in post stroke patients. On the other hand, stimulation of the Arnold nerve, the auricular branch of the vagus, triggers the cough reflex Arnold's ear cough reflex. Capsaicin, an agonist of Transient Receptor Potential Vanilloid 1 TRPV1 , has been shown to activate the peripheral sensory C fibers. Stimulation of the sensory branches of the vagus in the laryngotracheal mucosa with capsaicin induces the cough reflex and has been reported to improve the swallowing function in patients with dysphagia. In our previous study, we showed that aural stimulation of the Arnold nerve with 0.025% capsaicin ointment improved the swallowing function, as evaluated by the endoscopic swallowing score, in 26 patients with dysphagia. In the present study, the video images of swallowing recorded in the previous study were re evaluated using the SMRC scale by an independent otolaryngologist who was blinded to the information about the patients and the endoscopic swallowing score. The SMRC scale is used to evaluate four aspects of the swallowing function : 1 Sensory : the initiation of the swallowing reflex as assessed by the white out timing ; 2 Motion : the ability to hold blue dyed water in the oral cavity and induce laryngeal elevation ; 3 Reflex : glottal closure and the cough reflex induced by touching the epiglottis or arytenoid with the endoscope ; 4 Clearance : pharyngeal clearance of the blue dyed water after swallowing. Accordingly, we demonstrated that a single application of capsaicin ointment to the external auditory canal of patients with dysphagia significantly improved the R, but not the S, M or C scores, and this effect lasted for 60 min. After repeated aural stimulation with the ointment for 7 days, the R score improved significantly in patients with severe dysphagia. The present findings suggest that stimulation of the Arnold's branch of the vagus in the external auditory canal with capsaicin improves the glottal closure and cough reflex in patients with dysphagia. Thus, aural stimulation with capsaicin represents a novel treatment for dysphagia. It is also suggested that repeated alternative aural stimulation with capsaicin for a week, rather than a single application, is needed to improve the swallowing function in patients with severe dysphagia. By the same mechanism as that underlying the effect of ACE inhibitors, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in patients with dysphagia.


Sakamoto Y.,Anan Kyoei Hospital | Shigekiyo Y.,Anan Kyoei Hospital
Japanese Journal of Chest Diseases | Year: 2010

A 65-year-old man was admitted to our hospital because of on-going episodes of dry cough and palpitation after oral ingestion of a powdered health food (AHCC®). On admission, hypoxemia was noted. The serum level of lactate dehydrogenase was elevated. Chest radiography and CT scanning revealed geometric ground-glass opacities and small centrilobular nodules in both lung fields. In the bronchoalveolar lavage fluid, the total cell count and the lymphocyte fraction were high, and the CD4/8 ratio was reduced. Based on these findings, we diagnosed hypersensitivity pneumonitis. The lymphocyte stimulation test was positive for the health food. Because it was known to contain mushroom extract, we speculated that this is an atypical case of mushroom workers' lung caused by accidental inhalation of mushroom extract.


Yoshida S.,Tokushima University | Aihara K.-I.,Tokushima University | Azuma H.,Anan Kyoei Hospital | Uemoto R.,Tokushima University | And 12 more authors.
Atherosclerosis | Year: 2010

Background: Dehydroepiandrosterone sulfate (DHEAS) is thought to be associated with life expectancy and anti-aging. However, its biological significance in atherosclerosis remains controversial. Therefore, the aim of this study was to determine whether DHEAS is associated with development of carotid atherosclerosis in subjects with cardiovascular risk factors. Subjects and methods: A total of 419 Japanese individuals (208 males and 211 females) were recruited from Tokushima University Hospital, Japan. In all subjects, maximum intima-media thickness (max-IMT) in all carotid arteries, and mean-IMT and mean blood flow volume (BFV) in the common carotid arteries (CCA) were measured by ultrasonography; endothelial function was assessed by flow-mediated vasodilation of the brachial artery (%FMD). Serum DHEAS and classical cardiovascular risk factors were also evaluated. Statistical significance was determined by multiple regression analysis to elucidate independent determinants of max-IMT, mean-IMT, mean CCA-BFV, and %FMD. Results: Serum DHEAS levels were higher in males than in females. Multiple regression analysis revealed that DHEAS was an independent negative factor for both max-IMT and mean-IMT in males but not in females. In contrast, DHEAS was the sole positive factor for mean CCA-BFV in females but not in males. In addition, there was no significant relationship between %FMD and DHEAS regardless of sex and other confounding factors. Conclusion: Although DHEAS is not involved in endothelial function, DHEAS is inversely associated with sex-dependent diverse carotid atherosclerosis such as increased max-IMT and mean-IMT in males and decreased CCA-BFV in females. © 2010 Elsevier Ireland Ltd.


Ogushi Y.,Tokushima University | Eguchi H.,Tokushima University | Kuwahara T.,Tokushima University | Hayabuchi N.,Eye Clinic Josanjima | Kawabata M.,Anan Kyoei Hospital
Japanese Journal of Ophthalmology | Year: 2010

Purpose: To elucidate the reservoirs of Pseudomonas aeruginosa keratitis associated with contact lens (CL) wear by using a molecular genotyping method. Method: Ten P. aeruginosa isolates obtained from two young adult patients with infectious keratitis associated with CL wear were studied. These were isolated from corneal specimens, conjunctival swabs, discharges, CL storage cases, and the living environment of the two patients. Species identification was performed with an Oxi/Ferm Tube II system using well-separated colonies on MacConkey and NAC agar plates. We employed molecular genotyping by pulsed-field gel electrophoresis. Results: We isolated three (one each from a corneal scraping, discharge, and a CL storage case) P. aeruginosa samples from patient 1, and seven (one each from the conjunctival swab, CL storage case, and the patient's fingers, and four from the patient's room) from patient 2. Pseudomonas aeruginosa of environmental origin could not be obtained from the house of patient 1. The genotypes of two P. aeruginosa isolates, from corneal scraping and discharge, were identical to that of the isolate from the CL storage case belonging to patient 1. In patient 2, the isolates from the eye and the CL storage case showed the identical genotype, which was different from those of the environmental isolates. Conclusion: Our results suggest that the causative P. aeruginosa strains in cases of infectious keratitis associated with CL wear originate in contaminated CL storage cases. However, it is still unclear whether the environmental strains in the patients' houses also cause keratitis. © 2010 Japanese Ophthalmological Society (JOS).


PubMed | Anan Kyoei Hospital
Type: Case Reports | Journal: No shinkei geka. Neurological surgery | Year: 2015

We report a woman whose anterior communicating artery (AcomA) aneurysm was clipped via an anterior interhemispheric approach when she was 49 years old. At the age of 51, she presented with a subcutaneous abscess and osteomyelitis, so the cranioplastic bone was removed. Six months later, she underwent cranioplasty using hydroxyapatite. Her subcutaneous abscess recurred and the epidural abscess and hydroxyapatite were removed 11 years later after the first operation. The patient underwent observation therapy for the next 4 years, as the dura was ossified. She presented with frontal swelling 15 years after aneurysmal clipping, and neither abscess puncture nor the administration of antibacterial drugs was curative. The patient also complained of chill, thirst, and tremor, and developed disorientation 25 days later. Computed tomography (CT) and magnetic resonance imaging (MRI) showed extension of the epidural and subcutaneous abscesses to a frontal brain abscess. After consulting an otolaryngologist, we performed frontal drainage into the nasal cavity. After making a bicoronal skin incision, the subcutaneous, epidural, and intracapsular brain abscesses were removed while taking care not to damage the capsules. A silicone T-tube was placed in the bifrontal epidural cavity (previous frontal sinus), and its tip was inserted into the nasal cavity through the nasofrontal duct for abscess drainage. After 3 months, the tube was removed. A CT scan acquired 10 years later showed no brain abscess, perifocal edema, or epidural and subcutaneous abscesses.


PubMed | Anan Kyoei Hospital and Tokushima University
Type: Journal Article | Journal: Clinical journal of gastroenterology | Year: 2016

Neuroendocrine carcinoma (NEC) of the pancreas is very rare, and its origin is not fully elucidated. Here, we present a case of a small-size NEC of the pancreas that is genetically similar to invasive ductal adenocarcinoma (IDA). A 65-year-old man was referred to our hospital due to obstructive jaundice and found to have a 12-mm solid tumor in the pancreas head. The tumor exhibited low vascularity on enhanced computed tomography, and endoscopic retrograde pancreatographic imaging revealed an irregular obstruction in a branch duct of the pancreas. The patient was thereby diagnosed with a pancreatic ductal cancer, and stomach-preserving pancreaticoduodenectomy with regional lymph node resection was performed. Histochemical analysis of the resected tumor showed that the neoplastic cells with scanty cytoplasm and hyperchromatic nuclei strongly expressed chromogranin A and synaptophysin. The Ki-67 index was 40% in the most proliferative tumor regions, and the tumor was diagnosed as a NEC of the pancreas. However, in the analysis of genetic alterations of the tumor tissue, the neoplastic cells showed altered KRAS, TP53, and SMAD4/DPC4, suggesting that the NEC in our case is genetically related to IDA. Our data suggest that poorly differentiated IDAs may transform into NECs.


Bando K.,Anan Kyoei Hospital | Ebisutani D.,Anan Kyoei Hospital
Neurological Surgery | Year: 2015

We report a woman whose anterior communicating artery (AcomA) aneurysm was clipped via an anterior interhemispheric approach when she was 49 years old. At the age of 51, she presented with a subcutaneous abscess and osteomyelitis, so the cranioplastic bone was removed. Six months later, she underwent cranioplasty using hydroxyapatite. Her subcutaneous abscess recurred and the epidural abscess and hydroxyapatite were removed 11 years later after the first operation. The patient underwent observation therapy for the next 4 years, as the dura was ossified. She presented with frontal swelling 15 years after aneurysmal clipping, and neither abscess puncture nor the administration of antibacterial drugs was curative. The patient also complained of chill, thirst, and tremor, and developed disorientation 25 days later. Computed tomography (CT) and magnetic resonance imaging (MRI) showed extension of the epidural and subcutaneous abscesses to a frontal brain abscess. After consulting an otolaryngologist, we performed frontal drainage into the nasal cavity. After making a bicoronal skin incision, the subcutaneous, epidural, and intracapsular brain abscesses were removed while taking care not to damage the capsules. A silicone T-tube was placed in the bifrontal epidural cavity (previous frontal sinus), and its tip was inserted into the nasal cavity through the nasofrontal duct for abscess drainage. After 3 months, the tube was removed. A CT scan acquired 10 years later showed no brain abscess, perifocal edema, or epidural and subcutaneous abscesses.

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